Centralized Facility Eligibility Unit

Applications Design Event Report Out

“Making History”

The Opportunity

Jaili Cunningham Department of Human Services Income Maintenance Administrator

Team Making History CFEU Applications Design Kaizen Team

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Team Making History

Lean Co-Facilitators Matt Haynes Ann Hogle

Iowa Department of Human Services

Team Members Jaili Cunningham, DHS CCA

Amie Schippa, DHS CFEU Erica Fitch, DHS CFEU Dawn Helm, DHS CFEU

Elaine Walker, DHS CFEU Kimberly Anderson, DHS DM SA

Patsy Walker, DHS CFEU

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Scope Amie

• This event will design a standardized, efficient, and clear method of processing CFEU applications from the time an application is received by CFEU to the time it is completed and forwarded for ongoing case maintenance.

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Objectives Amie

• Design a process that includes clear and efficient utilization of ECF.

• Create a process flow map for the new process.

• Document the new process in text to use for training staff and reference immediately after the event (Mon. 3/7/11)

• Streamline any and all processes/procedures we can and clearly detail standardized steps (i.e. attributions, Miller Trust, burial contracts, application form to be utilized, narrative section, use of addendum, etc.)

• Establish comfortable case load levels

• Establish better communication with facilities

• Create standardized resource list for staff reference

• Establish a sense of a “single team” between Apps and Ongoing staff & determine best way to share resources

• Clearly define the appeals process

• Test the new process prior to training all staff

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Goals Amie

• Reduce lead time for pending applications to within 1 working day of receipt of the application

• Reduce lead time for completing RFIs by app workers to w/in 1 working day of the app being pended

• Ensure application decisions are made within 60 days of the application date, meeting the established KPM.

• Improve the work environment as measured by a 50% reduction of overtime.

• Determine a reasonable carryover case load for CFEU app workers.

Kaizen Methodology Ann

• Clear objectives • Team process • Tight focus on time • Focus on reducing steps, reworks,

duplications • Necessary resources immediately available • Immediate results (new process designed

by end of 3-days)

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Trends Elaine

– Baby Boomers getting older & have more resources – Most Baby Boomers are still married and may enter facility

together – State cut-backs/Layoffs/Hiring freeze – Healthcare Reform – Potentially more centralization/smaller government – Move from more direct service contact we provide much

lighter & remote touch – Facilities more stringent on accepting individuals – Facility staff turnover is increasing, staff not trained or

knowledgeable – Supervisor ratio worse – less time (quality) with staff – Iowa has higher percentage of elderly population

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SWOT Erica

• Some of the Strengths of the CFEU – Intake workers, ongoing workers, all facility

resources together “centralized” – One program “Facilities” – Smart, hardworking, dedicated, GREAT staff – Less staff can process apps when working

with one program – Info to one place rather than across the state – Policies can be consistently applied more

easily

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SWOT Erica

• Select Weaknesses

– Not fully staffed at 20, until January 16/18 workers new to facilities, 8-9 new to DHS

– Not enough tools, resources, etc capabilities, ISIS not ready

– Rollout – Less client contact, no interviewing required – Less communication with clients, no time – Unable to get files/attributions from local

offices 11

SWOT Erica

• Select Opportunities

– Model for centralization, example for others – Policy change to serve all parties – Standardize/streamline processes – Better communication with facilities – Process with less staff – Help to develop other centralized units – Develop process that will help throughout the

state

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SWOT Erica

• Select Threats – The feeling if we do not succeed – the unit will

be discontinued – Layoffs/cutbacks – the effect on caseload and

supervisor/employee ratio – Systems down – Higher caseloads/applications – Facility turnover – Budget cuts

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Brainstorming Kim

• Revise the Application • Develop case face sheet for Facility/Waiver

cases • Revise other necessary forms • Support staff pending applications • Increase communication • Increase training based upon needs • New process for ECF • Revise imperative policies • Delete the Application Register

• Identifies – Impact to

customer – Difficulty

implementing

• Helps to rate/rank solutions to resolve issues while identifying ease of implementation

De-Selection Process Kim

I III

II IV

I

M

P

A

C

T

D I F F I C U L T Y

Application, Appeals & Attribution Dawn

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New Applications CFEU

Ap

plica

tion

Wor

ker

Job

Sear

chAp

plica

tion

Wor

ker

Clie

ntSc

an C

ente

rSu

ppor

t Sta

ff

Send in Application

Receive Application

Index Application

with 00

Delay2 days

Open Process LIst

Sort by document type

Clear app by checking ABC

NIs this a Y CFEU App

YDenied past 30 days N

or dup

NIs it a Y

redert

NIs this a Y

Review

Assign to appropriate

county process list

Assign to Rev. worker alpha split – put in process list

Assign to alpha-split

redert worker process list

Log App into App Log

Assign to previous App

worker

Log app into App Log

Assign App to intake worker TPQ2 Request

Add Case # & State ID into

ECF Document

Put into assigned workers

process list

Pend spouse on 55-FBU w/

143-643 A type

Y

Spouse N

TPQ2 Request

Pend Application

Check ECF process list

Assess App and attached

info

NKnow

Facility Y Name

RFI requests name of facility

Fax CAR/LOC form to Facility& upload ECF

Upload App and info to

catalog

Complete Face Sheet

RFI? NY

Type RFI Letter

Set Tickler 3 days after due date in LF01- (due on this

date, deny on this date)

Print 2 copies Upload to ECFKeep 1 copy

with face sheet in 1-31 file

Mail copy to client/POA with

Packet

YExtension N Requested

YExtension N

Granted

Delete previous tickler

and set new tickler

Make RFI to new due date

in 1-31 fileDelay

Document in OLN missing information

Set tickler for 17th day

N Client info rec. by Y

day 17

Re-pend application

Answer ISIS Milesones

NICF? Y

Decision from IME via ISIS

milestone

Answer ISIS milestone

Process Application

Put case in ongoing

worker # TDO1

Upload face sheet to ECF

NAll req. info Received Y from client

Shred RFI Upload face sheet End

End

Delay0-30 days

Fax CAR/LOC form to Facility

– upload in ECF

Additional Info NNeeded

from client

Receive faxed CAR/LOC form

Send CAR to App worker

Send LOC assessment to

IME

Review Face Sheet

Approve Y

N

Deny case in ABC

Upload Face Sheet

NICF? Y

YCase

Activity N Report

IME Delay

Decision from IME via ISIS

milestone

Answer ISIS MIlestone

Process Application

Send IS Intent to Transfer

Letter in cases of CS

Set Tickler for due date if IS

intent to transfer CS

Put case in ongoing

worker # TD01

Upload Facesheet to

ECFEnd

Facility Delay

Send Second CAR/LOC to Facility – no earlier than 1

week from first request

Note on initial request form if this is second

request

Receive CAR

Facility Delay

Delay14 days

Delay 1day

DelayIME

Send IS intent to transfer letter if CS

Set tickler due date of IS

Intent Letter for CS

3 out to Attribution

4 in from Attribution

End

2 out

2 in

Deny apps for not providing info in ABC

Appeals

Superv

isor

Polic

yA

pplic

ation W

ork

er

Appeals

Clie

nt/P

OA

Client receives NOD

Appeal in writing

AppWorker Y

N

Receive Req for Appeal in

writing

Receive Request for Appeal from

client in writing

E-Mail Appeal to Appeals Department

Receive e-mail from Appeals Department

Worker go to AIS and check appeal request

If necessary e-mail NOD to appeals Dept

Print information on

AIS

Complete appeal

summary – within 10 days

Fax to Appeals Dept

Mail copy to Client/POA File

Delay

Receive E-mail from AIS re:

Notice of Telephone

Hearing

Print Notice for File

Enter hearing date into Outlook

Send e-mail invitation to

Amie of hearing

Attend Hearing

Review Desired N

Y

Receive e-mail re: proposed

decision

Take necessary

action

NAction Y Required

Send packet to scanning

Send packet to scanning End

End

RequestReview N

Y

Policy manager reviews requests

Supervisor sends request

to Policy Manager

Receive Appeal request

from App worker

Delay Delay

Receive e-mail regarding proposed decision

Print for file

Delay

Print for file

Attribution

Applic

ation W

ork

er

Pull up Resources

Upon Entering Medical Facility

Complete Attribution Worksheet

Complete Notice of

Attribution of Resources

Upload to ECF

3 in

Mail copy to client

4 out

Application Process Highlights Patsy

• Consistent work practice, with training manual

• New fax sheet to communicate with health facilities

• New Face Sheet for workers to use • Support Staff pending applications and

assign to workers • Daily priority order for all app workers

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Homework Patsy

Item Item Description Person Responsible Due Date

1 Turn process map into text for training manual Matt, Amie 3/7/11

2 Training on new process to Application Workers Dawn, Erica 3/10/11

3 Create transition plan and roll out of new process Jaili, Elaine 3/9/11

4 Schedule Training for ECF for all CFEU application employees – in Training Room 1 Patsy, (John Tvedt), Jaili 3/9/11

5 Monthly Training for CFEU scheduled Topics based upon suggestion box or if data shows an area declining (First training – appeals process – exhibits, etc.)

Amie 3/14/11

6 Create a Face Sheet to be used by all Application Workers Dawn, Erica, Marcy O., Patsy, Kim 3/4/11

7 Create Attribution Worksheet form for app workers to use for attribution cases Elaine, Marcy O, Patsy, Kim 3/4/11

8 Guidance and develop standard RFI Language (cut and paste language) for burials, VA Dawn 3/7/11

9 Create an info sheet regarding burial contracts to be used with clients and funeral homes. Amie 4/7/11

10 Design and implement fax for LOC to send to facilities 1st and 2nd notices – make part of ECF – include

stronger language Elaine (Kim) 3/7/11

11 Create OLN guidance document – consistent practice – i.e. document phone calls, etc. Jaili 3/7/11

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Develop protocol for handling case phone calls after the case is handed off to on-going and communication plan, include a couple examples (no RFI or extensions by CSC on app cases)

Develop protocol (recommendation) for Customer Service interaction with applicants

Dawn, Erica, Veronica 3/7/11

13 Develop a new Facility assistance questionnaire Amie, Jaili, Dawn, Erica 3/7/11

14 Train Julie on her new process Elaine, Amie, Kim Grasty 3/8/11

15 Develop a new facilities application and follow protocol to get application updated Denise, Jaili, Amie, Dawn, Erica 9/1/11

16 Develop a daily priority order Jaili, Dawn, Erica 3/3/11

17 Develop organization of workspace - Develop Tickler process & 1-31 filing process (define how to

calculate the actual tickler dates) Jaili, Dawn, Erica 3/3/11

18 Identify process for duplicate applications Kim 3/3/11

19 Process to assign applications to workers for the support staff & Create Application Log Matt, Julie, Teresa, Amie 3/4/11

20 Determine what goes out in packets – process Denise, Amie 3/4/11

21 Create internal tracking for case reading Elaine 4/3/11

Homework Patsy

Homework Patsy

22 Determine process for CAR’s received before application – communicate plan to

eliminate Amie 3/14/11

23 Grace Period Clarification – communicate clarification Kim, Dawn, Erica 3/9/11

24 Determine process for Miller Trust Elaine, Amie 3/8/11

25 Develop a resource list of other agencies such as VA, SSA, etc. Jaili 3/11/11

26 ISIS/IABC Logout Times Extended (Research other systems logout times, Get SAMs support for extending logout times, IABC/CWIS Approval, Implementation

Jaili 6/1/11

27 Create SharePoint and identify information needed Matt, Jaili, Amie 3/4/11

28 Clarify intent to transfer process assets (approval needed by Denise) Amie 3/4/11

29 Training for facilities Jaili, Denise 6/1/11

30 Timeline for taking applications back from field – anything we need to do prior to March 14th. Jaili, Kim 3/3/11

31 Identify process to ensure scanning/faxing is current in ECF (Jaili will print out e-mails and bring to 30-day, etc.) Matt, Jaili Revisit at 30-60-90 day follow-ups

32 Develop protocol and guidance for assessing application Amie 3/10/11

Team Members Experience

Comments

Matt Haynes Lean Co-Facilitator, Iowa Department of Human Services

Ann Hogle Lean Co-Facilitator, Iowa Department of Human Services

WE WELCOME YOUR QUESTIONS AND COMMENTS!

Thank you for attending.

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